In recent years, the incidence of gynecological tumors has increased year by year, making the terms cervical cancer and ovarian cancer no longer unfamiliar to us. Cervical cancer is the most common gynecological malignant tumor. In addition, it is also the three major gynecological malignant tumors along with ovarian cancer and endometrial cancer. Gynecological izicubu are harmful to women. Early detection and early diagnosis can often help treatment and improve the survival time of patients.
Inqubekelaphambili esheshayo yokwelashwa okuhlosiwe kanye ne-immunotherapy isithuthukise kakhulu isimo seziguli ezinomdlavuza wezifo zabesifazane. Umhleli uzobheka imishanguzo yokwelapha eqondiswe kwesimila se-gynecological kanye nemithi ye-immunotherapy egunyaziwe.
Ukwelashwa okubhekiswe kumdlavuza we-Gynecologic
Ukwelashwa okubhekiswe kumdlavuza we-Ovarian
① I-Bevacizumab
②PARP inhibitor
I-Olaparib (Olapani, Lynparza), i-rucaparib (i-Rucapa, i-Rubraca) ne-niraparib (i-Nilapani, i-Zejula)
Imithi yokwelapha ebhekiswe kumdlavuza wesibeletho
I-Bevacizumab (Bevacizumab, Avastin)
Ukwelashwa okubhekiswe kumdlavuza we-Endometrial
Sebenzisa ama-hormone noma izidakamizwa ezivimba ama-hormone ukulwa nomdlavuza. Izidakamizwa zokwelashwa zifaka:
Ø I-Progesterone: i-medroxyprogesterone acetate ne-megestrol acetate
I-Tamoxifen
Ø Ukunciphisa ama-hormone agonists akhipha ama-hormone: Goserelin (Norred®) kanye neLeuprolide (Leuprolide®). Le mithi ijojowe njalo ezinyangeni eziyi-1-3
Ø I-Aromatase inhibitors: i-letrozole (i-Fronon®), i-anastrozole (i-Reninide®), i-exemestane (i-Anoxin®)
Ukwelashwa okubhekiswe esibelethweni se-sarcoma
I-Panzopinab (Votrient) iyindlela yokwelashwa ebhekiswe engasetshenziswa ukwelapha i-leiomyosarcoma esakaze noma yabuya emuva kokwelashwa.
Ø I-Olaratumab (Lartruvo) ehlanganiswe nesidakamizwa se-chemotherapy i-doxorubicin ukwelapha i-sarcoma yezicubu ezithambile. Ingasetshenziselwa ukwelapha i-uterine sarcoma engaphenduli kwezinye izindlela zokwelapha.
I-Gynecological tumor immunotherapy
I-Immunotherapy ingumqondo omusha, ongasetshenzisiwe kakhulu njengokuhlinzwa, ukwelashwa ngamakhemikhali kanye ne-radiotherapy. Kodwa-ke, yenze inqubekelaphambili enkulu ekuthuthukiseni ukusinda kweziguli ezinomdlavuza wamaphaphu othuthukile, i-melanoma, umdlavuza wezinso, i-Hodgkin's lymphoma nokunye. Isidakamizwa esisodwa kuphela esigunyazwe i-gynecological tumor immunotherapy! Kodwa ezimweni ezimbili ezahlukene, umuthi inkanyezi pembrolizumab (Pembrolizumab, Keytruda).
I-Pembrolizumab (Keytruda) iqondise ku-PD-1, okuyiphrotheni kuma-T cell futhi ngokuvamile esiza ukuvimbela lawa maseli ukuthi ahlasele amanye amaseli emzimbeni. Ngokuvimbela i-PD-1, le mithi ingathuthukisa ukusabela kwamasosha omzimba kumaseli omdlavuza, okubangele ukuthi ezinye izimila zishwabane noma zembese ukukhula kwazo.
I-MSI-H Gynecologic Oncology
Ngomhla zingama-24 kuMeyi, 2017, i-US FDA igunyaze i-PD-1 inhibitor pembrolizumab (Pembrolizumab, Keytruda) ukuthi yelaphe iziguli zesimila esiqinile ezine-microsatellite engazinzile kakhulu (MSI-H) / ukukhubazeka kokulungisa okungahambi kahle (dMMR) Izinhlobo zesimila zimboza izimila ezimbi eziyi-15 ezahlukahlukene. okuhlanganisa umdlavuza wesibindi, umdlavuza wekoloni, umdlavuza wamaphaphu nomdlavuza womlomo wesibeletho, okuhlanganisa nezimila ezihlukahlukene zabesifazane. (Qaphela: Uma i-MSI-H itholwa, akunandaba ukuthi kusesekuseni noma sekwephuzile, ungazuza)
Umdlavuza omuhle wesibeletho se-PD-L1
NgoJuni kulo nyaka, i-US FDA yasheshisa ukuvunywa kwe-pembrolizumab (Keytruda) yokwelashwa kweziguli zomdlavuza womlomo wesibeletho ezithuthukisiwe ze-PD-L1 ezinesifo esathuthuka phakathi noma ngemuva kwe-chemotherapy. Imvume ichaza ukuthi iPD-L1 inomdlavuza njengomdlavuza womlomo wesibeletho onamaphuzu ahlanganisiwe (CPS) ≥1 edlulise imiphumela yokuhlolwa evunyelwe yi-FDA. Kubalulekile ukusho ukuthi, njengamanje, i-Keytruda futhi iyindlela yokuqala futhi evunyelwe kuphela yokwelapha i-anti-PD-1 yomdlavuza wesibeletho osezingeni eliphakeme.
Umuthi we-immunotherapy unikezwa njalo emavikini amathathu futhi unikezwa ukumnika okufakwa emthanjeni (IV). Njengamanje ibhalwe eChina futhi ingena kumshwalense wezokwelapha. Iziguli zasekhaya zingaya esibhedlela sendawo ukuyobonisana, noma zishayele i-Global Oncologist Network (3-400-626) ukuthola imininingwane enemininingwane mayelana nokwelashwa komdlavuza wesibeletho i-pembrolizumab.
Ukuvunyelwa kwakususelwa kudatha evela ezigulini ezingama-98 ezinomdlavuza ophindwe wabuyela emuva noma we-metastatic esivivinyweni sesiGaba II KEYNOTE-158. Lolu cwaningo lomhlaba wonke, oluvulekile, olungahleliwe, oluningi, nolwenzelwe izinto eziningi luhlolisise i-pembrolizumab ekwelapheni iziguli ezinezinhlobo eziningi zamathumba aqinile athuthukile, futhi lezi ziguli zenze inqubekela phambili kumaphrothokholi ajwayelekile okwelashwa.
Isikhathi sokulandelela esiphakathi kwaba yizinyanga eziyi-11.7 (ububanzi 0.6-22.7). Isilinganiso sokusebenza okuphelele (i-ORR) seziguli ezingama-77 PD-L1 ezinhle (i-CPS-1) sasingu-14.3%. Lezi ziguli bekuyizo zonke iziguli ezinesifo se-metastatic ezithola line 1 umugqa we-chemotherapy. I-ORR inezinga eliphelele lokuphendula elingu-2.6% kanye nenani lokuphendula ngokwengxenye elingu-11.7%. Isikhathi sokuphendula esiphakathi asifinyelelwanga (ububanzi bezinyanga eziyi-4.1 kuya ezinyangeni eziyi-18.6 +), kanti ama-91% wabaphenduli baba nesikhathi sokuphendula sezinyanga eziyi-6 noma ngaphezulu.
Ezigulini ezine-PD-L1 expression CPS <1, ayikho impendulo ebikiwe.
"Yize kube nentuthuko eningi emdlavuzeni wabesifazane, phambilini iziguli eziphethwe umdlavuza womlomo wesibeletho zisenazo izindlela ezintsha zokwelashwa," kusho uBradley Monk, isazi somdlavuza wase-Arizona, umqondisi wezokwelapha we-American Gynecology Research oncology Programme kanye noprofesa wezokubelethisa nowesifazane. Esitatimendeni,
"Ukwamukelwa kukaKeytruda kulokhu kubonisa izindaba ezibalulekile-njengodokotela womdlavuza, kuyajabulisa ukubona ukukhetha okudingeka kakhulu kulezi ziguli," kusho uMonk.
Ukuhlukaniswa kweziguli ezingama-77 ngempendulo yokwelashwa kwakungu: 92% squamous cell carcinoma, 6% adenocarcinoma, kanye ne-1% adenosquamous carcinoma. Iziguli ezingama-95% zine-metastases, kanti ama-20% abuyela emuva. I-PD-L1 IHC 22C3 pharmDx kit isetshenziselwe ukuthola isimo se-PD-L1.
Iziguli zathola i-200 mg pembrolizumab njalo emavikini ama-3 kuze kube izinyanga ezingama-24 noma ihoxile ekwelashweni ngokuzenzekelayo, noma isiqinisekiso semisebe yokuqhubeka kwesifo, noma ubuthi obungamukeleki noma ngokuya ngesinqumo somphenyi. Iziguli ezizinzile emtholampilo ezinenqubekela phambili ye-radiological zingaqhubeka nokwelashwa kuze kube yilapho inqubekela phambili iqinisekiswa yimifanekiso elandelayo. Inqubekela phambili yesimila yahlolwa njalo emavikini ayi-9 ngonyaka wokuqala, futhi njalo emavikini ayi-12 ngemuva kwalokho.
Okuvame kakhulu (≥10% yeziguli) kubike izehlakalo ezimbi (AEs) kuwo wonke amazinga kufaka ukukhathala (43%), ubuhlungu (22%), umkhuhlane (19%), i-peripheral edema (15%), nobuhlungu be-musculoskeletal (27 %)), Uhudo / colitis (23%), ubuhlungu besisu (22%), isicanucanu (19%), ukuhlanza (19%), ukuqunjelwa (14%), ukuncipha kwesifiso sokudla (21%), ukopha (19%), I-UTI (18%), ukutheleleka (16%), ukuqubuka (17%), i-hypothyroidism (11%), ikhanda (11%) ne-dyspnea (10%).
Ibanga elivame kakhulu u-3/4 AE lifaka phakathi i-UTI (6%), ukopha (5%), ubuhlungu be-musculoskeletal (5%), ukukhathala (5%), ukutheleleka (4.1%), ubuhlungu besisu (3.1%), ubuhlungu (2) )%), I-Peripheral edema (2%), ukuqubuka (2%), ikhanda (2%), isifo sohudo / i-colitis (2%), ukuhlanza (1%), i-dyspnea (1%) nomkhuhlane (1%)).
Ukuyekiswa kokwelashwa okuhlobene ne-AE kwenzeka kwiziguli eziyi-8%. Ama-AEs anzima enzeka ezigulini ezingama-39%, okuvame kakhulu ukuba yi-anemia (7%), fistula (4.1%), ukopha (4.1%), kanye nokutheleleka (ngaphandle kwe-UTI; 4.1%).
Ukugunyazwa kwe-gynecological tumor immunotherapy ngokungangabazeki kuzongeza utshani obusindisa ukuphila, enye indlela yokwelashwa, kanye nethemba elilodwa lokusinda ezigulini ezimelana nokwelashwa ngamakhemikhali, ukwelashwa ngama-hormone, kanye nokwelashwa okuqondiwe. Kusukela kulokhu okungenhla, siyabona ukuthi i-gynecological tumor immunotherapy ayifaneleki kuzo zonke iziguli. Ngaphambi kokwelashwa, kufanele kuhlolwe izimpawu zesimila ezimbili: eyodwa i-MSI enye i-PD-L1. Iziguli ezihlangabezana nezindinganiso zifaneleka kakhulu.
Nakuba i-pembrolizumab isivele imakethwa e-China, ezinye iziguli zingase zibe nomuzwa wokuthi intengo yalo muthi ibiza kakhulu. Uma ufuna ukonga izindleko zokuhlolwa kofuzo, hlola ngokungaboni i-pembrolizumab. Le ndlela nayo ayimbi, kodwa imvamisa uma lokhu kunganconyiwe, ukwelashwa kwe-pembrolizumab ngokwako kuzodala imiphumela engemihle futhi kungaba nemiphumela engemihle ekwelashweni kwesiguli.
Uma umhlomulo ungaqinisekisiwe, ungahle wehliswe futhi uthinte isimo.
For cancer friends whose survival period is not optimistic, the doctor ‘s estimate may be less than 6 months, and the economic conditions are not good. In this case, if you take half a month to wait for an uncertain result, it seems too risky, so It is better to conduct a blind test directly, use the money on the blade, and select the most probable one to try, commonly known as “Chuangyun”.
Yiqiniso, ukuhlolwa okuyimpumputhe nakho kunakho ukushiyeka. Ngaphambi kokuhlolwa kofuzo, umuthi ngokuyisisekelo uncike “ekuqageleni”, futhi umphumela ngokuyisisekelo uncike “ekukhulekeni”.
